What you need to know about the On-Site Support model

Last week, I was working in my office, taking notes of a meeting, when I forgot I had turned the volume up too high, triggering my startle reflex, causing me to spasm and, therefore, knock the keyboard onto the floor. Rather than wait for my scheduled support to come in five hours, I could call a support worker to come for 10 seconds, get them to pick up the keyboard, and put it on my tray, allowing me to continue my work with minimal delay.

Using the On-Site Support (OSS) model of funding (sometimes interchangeably called Concierge support), I can access on-call the Supported Independent Living (SIL) support from a trusted provider. I believe OSS can also address some of the policy challenges with the ongoing cost of SIL.

So, what is OSS support, and how does it work? Which participants are best suited to the OSS model? What are the benefits and potential drawbacks for providers who may wish to explore the viability of taking on such a service?

What is OSS?

OSS can complement daily living supports used by participants with Specialist Disability Accommodation (SDA) funding. As the name suggests, OSS can be used when multiple participants live separately, or sometimes together, on the same site. OSS is intended to provide ad hoc support for emergencies or drop-in support as required.

People have a lot of flexibility in how they use OSS. For example, it can be used at specific times of the day for small, consistent tasks such as toileting or transferring in and out of bed. OSS support can also be used for an emergent or a quick response to unexpected support that may arise outside of the participant's standard support hours.

OSS is a stated line item in a plan, usually charged weekly. The line item is in the NDIS Pricing Arrangements and Price Limits Document (PAPL) under the title of 'Unplanned On-site Shared Supports in Specialist Disability Accommodation'.

OSS providers often work closely with the SDA provider to win the service contracts. Ultimately though, the residents usually determine who provides the service through a voting process undertaken (usually) annually.

Who is best suited to OSS?

However, not everyone is suitable for OSS. People with variable conditions would have to consider whether OSS would be safe for them. The PAPL is very clear that OSS should not exceed 2.5 hours per day per participant and people must be able to safely wait at least one hour for staff to arrive, as there may be times when they are assisting another person on the site. If a participant has funding for 24/7 constant support, they might also not be eligible for OSS, as the NDIA may consider this a duplicate of existing funding.

Although my own experience above exclusively relates to physical disability, participants with other impairments can also successfully utilise the OSS model. There can also be people with different types of disabilities on the same site.

What providers need to consider

Providers considering administering OSS might wish to investigate several things. To successfully provide OSS, providers must have a strong relationship with their participants to ensure their needs are met, and their funding can be maximised effectively. They should also ensure the services is complementary to all participants who share support.

Providers must also have a solid financial foundation to account for times when the site is not fully occupied. Because losing one participant's level of OSS funding without a replacement can have serious financial consequences. This might also involve working with the NDIA and the participant to ensure new funding can be approved as quickly as possible, which can be difficult. There might also be a transition period for residents to understand how the model works and incorporate it into their existing supports.

OSS and the NDIS Review

The NDIS Review believed the home & living market had not achieved its potential. The Final Report sought to identify opportunities for new housing and support models to be created and tested. Although not directly identified in the Report, OSS could represent one way to achieve these objectives.

Recommendation 8 looks explicitly at funding home and living supports that are ‘fair and consistent’ for participants so they can exercise ‘genuine choice and control.’ As part of this, the default configuration for SIL Support would be one support worker for every three participants (1:3), with residents typically living together. However, OSS provides opportunities for participants to share supports on the same site, without having to share with individual dwellings. One of the most popular configurations for OSS in urban areas is the 1:10 apartment model, which is more than three times the amount of participants suggested by the Review. However, this would not be a solution for people who require 24/7 constant support, or more than 2.5 hours of on-call support a day.

Recommendation 8 of the report seeks to ensure that housing and support are managed by different providers, which is already standard practice within the OSS model.

When delivered appropriately, OSS is a win-win situation for the participant, provider and the NDIA. The participant has access to customised supports that suit their needs, while the provider can deliver consistent services that are responsive and flexible. OSS also makes economic sense for the NDIA, as it can save money by reducing the need for 24/7 constant support. OSS has the potential for growth in an area of the Scheme that most agree needs significant reform.